脊柱肿瘤术前栓塞血供评价：MR动态增强与DSA对照研究

发布时间：2018-05-25 05:14

本文选题：脊柱肿瘤 + 栓塞　；参考：《第二军医大学》2014年硕士论文

【摘要】：研究背景：选择性动脉栓塞是脊柱肿瘤外科术前常常采用的一项安全有效的辅助治疗方法。有研究认为，只有富血供的肿瘤进行术前栓塞才有意义，对乏血供肿瘤行术前栓塞可能是没有必要的。因此，术前评价脊柱肿瘤血供状态对指导临床治疗非常重要。MR动态增强可以发现肿瘤血流动力学的异常，区分富血供及乏血供肿瘤，术前提供有价值的信息。但目前对脊柱肿瘤，缺少MRI动态增强与DSA血管造影的对照研究，术前是否可用MRI动态增强评价肿瘤血供尚不明确。本课题对拟行外科切除术的脊柱肿瘤病人，术前采用MR动态增强与DSA血管造影对照，研究其评价脊柱肿瘤血供状态的价值，探讨术前栓塞对脊柱肿瘤外科治疗的临床意义。第一部分MR动态增强与DSA对照对脊柱肿瘤血供状态的评价研究目的:通过与DSA血管造影对比，探讨MR动态增强评价脊柱肿瘤血供状态的价值。材料与方法:2012年7月至2014年1月行脊柱肿瘤术前栓塞的患者，共40例，其中男23例，女17例，平均年龄47岁（16-74岁），入院后均行MR动态增强扫描，之后于术前完成DSA引导下选择性动脉栓塞，外科切除后取得病理。研究脊柱肿瘤的动态增强曲线参数及DSA染色表现,探讨其相关性,以DSA染色为金标准绘制ROC曲线，得出曲线下面积AUC ROC。结果：肿瘤动态增强曲线的最大斜率Slopemax、肿瘤与正常椎体最大斜率比值S1/S0与DSA染色的相关性分别为0.847、0.899（均P0.01）。S1/S0、Slopemax判断脊柱肿瘤乏血供的ROC曲线下面积分别为0.971、0.930（P0.01），此时S1/S0的cut-off值为1.325（敏感性87.5%，特异性100%）。S1/S0、Slopemax判断脊柱肿瘤富血供的ROC曲线下面积分别为0.988、0.979（P0.01），此时S1/S0的cut-off值为1.870（敏感性100%，特异性96.4%）。MR强化程度判断脊柱肿瘤乏血供与富血供的ROC曲线下面积分别为0.547、0.697，均P0.05。结论：MR动态增强可以更为精确地判断脊柱肿瘤病变的血供程度，与DSA血管造影有很好的一致性，是一个术前评价血供的良好指标，有很大的临床应用价值。第二部分: MR动态增强鉴别脊柱良恶性肿瘤的价值研究目的:探讨MR动态增强鉴别脊柱良恶性肿瘤的价值。材料与方法:2012年7月至2014年1月行脊柱肿瘤外科切除的患者，共40例，男23例，女17例，平均年龄47岁（16-74岁），入院后均行MR动态增强扫描，行外科手术切除并取得术后病理。研究动态增强曲线参数、MR强化程度等在脊柱良、恶性肿瘤鉴别中的意义。结果：脊柱良、恶性肿瘤的MR强化程度有统计学差异，，Z=-4.019，P0.01；良、恶性肿瘤的动态增强曲线类型无明显统计学差异，Z=-0.556，P=0.578。肿瘤与正常椎体最大斜率比S1/S0、肿瘤最大斜率Slopemax、最大强化值Emax、最大强化比ERmax、达峰时间TTP等指标在良、恶性肿瘤分组中的表现无统计学差异，均P0.05。结论：MR动态增强曲线在脊柱良、恶性肿瘤中的表现无明显统计学差异，不能单独用作判断，学结合其他形态学改变。第三部分:脊柱肿瘤外科术前血管栓塞的临床意义研究目的:对比脊柱肿瘤术前栓塞后行外科切除术中出血、围手术期输血量及并发症的差异，评价术前栓塞的临床应用价值。材料与方法:2012年07月至2014年01月拟行脊柱肿瘤外科切除术的患者，共80例，术前栓塞组40例，平均年龄47.0±15.9岁，其中男性24例，女性16例，胸椎病变18例，腰椎病变9例，骶椎病变13例。对照组（未栓塞）40例，平均年龄46.1±17.9岁，其中男性25例，女性15例，胸椎病变17例，腰椎病变13例，骶椎病变9例。对比2组病例术中出血量、围手术期输血量及并发症差异。结果：栓塞组40例患者共对188支肿瘤供血血管进行了造影，对其中的167支供血血管进行了栓塞。栓塞组术中出血量1740±746ml,对照组术中出血量2516±1374ml，两者之间有明显统计学差异（P0.01）。栓塞组围手术期输血量1425±1348ml，对照组1845±1348ml，两组之间无明显统计学差异（P0.05）。栓塞组无一例栓塞并发症及手术并发症，对照组2例手术并发症。结论：脊柱肿瘤术前栓塞是一项安全有效的措施，可以显著降低术中出血量，减少术中并发症。
[Abstract]:Background: selective arterial embolization is a safe and effective adjuvant therapy that is often used before spinal tumor surgery. Clinical therapy is very important for.MR dynamic enhancement, which can detect abnormal hemodynamics of tumor, distinguish rich blood supply and lack of blood supply, and provide valuable information before operation. However, it is not clear that MRI dynamic enhancement can be used to evaluate the blood supply by dynamic enhancement of MRI before operation. The value of MR dynamic enhancement and DSA angiography was used to evaluate the value of the evaluation of the state of blood supply of spinal tumors and the clinical significance of preoperative embolization on the surgical treatment of spinal tumors.
Part MR dynamic contrast-enhanced DSA evaluation of blood supply status of spinal tumors
Objective: To evaluate the value of MR dynamic enhancement in evaluating the blood supply state of spinal tumors by comparing with DSA angiography.
Materials and methods: from July 2012 to January 2014, 40 cases of spinal tumor preoperative embolization were performed, including 23 males and 17 females, with an average age of 47 years (16-74 years old). MR dynamic enhanced scan was performed after admission. Then, selective arterial embolization was performed under DSA guidance before operation, and pathology was obtained after external excision. The dynamic enhancement curve of spinal tumor was studied. Parameters and DSA staining were performed to explore the correlation. DSA curve was used as the gold standard to draw ROC curve, and the area under the curve AUC ROC. was obtained.
Results: the maximum slope Slopemax of the tumor dynamic enhancement curve, the correlation of the ratio of S1/S0 to the maximum slope of the tumor and the normal vertebral body was 0.847,0.899 (P0.01).S1/S0 respectively. The ROC curve under the ROC curve of the spinal tumor for the spinal tumor was 0.971,0.930 (P0.01), respectively, and the S1/S0 cut-off value was 1.325 (sensitivity 87.5%, respectively). Heterosexual 100%).S1/S0, Slopemax determined that the area under the ROC curve for the blood supply of spinal tumors was 0.988,0.979 (P0.01), and the cut-off value of S1/S0 was 1.870 (sensitivity 100%, specificity 96.4%).MR strengthening degree to determine the area under ROC curve under the ROC curve of spinal tumor and rich blood supply respectively 0.547,0.697, P0.05.
Conclusion: the dynamic enhancement of MR can be more accurate in judging the blood supply of the spinal tumor, and it is in good agreement with the DSA angiography. It is a good index to evaluate the blood supply before operation, and has great clinical value.
The second part: the value of dynamic enhanced MR in differentiating benign and malignant tumors of the spine.
Objective: To investigate the value of dynamic contrast-enhanced MR in differential diagnosis of benign and malignant spinal tumors.
Materials and methods: from July 2012 to January 2014, 40 cases of surgical resection of spinal tumors were performed in 40 cases, 23 males and 17 females, with an average age of 47 years (16-74 years old). After admission, the dynamic enhanced scan was performed with surgical excision and postoperative pathology. The parameters of dynamic enhancement curve and the degree of MR enhancement were used in the identification of benign and malignant tumors of the spine. Significance.
Results: there was a statistical difference in the degree of MR enhancement of benign and malignant tumors of the spine. There was no significant difference in the dynamic enhancement curve of Z=-4.019, P0.01, benign and malignant tumor. The maximum slope of Z=-0.556, P=0.578. tumor and normal vertebral body was S1/S0, the maximum slope Slopemax, the maximum strengthening value Emax, the maximum enhancement ratio ERmax, and the peak time TTP and so on. There was no significant difference in the scores of benign and malignant tumors, P0.05.
Conclusion: there is no significant difference in MR dynamic enhancement curve in benign and malignant tumors of spine.
The third part: the clinical significance of preoperative embolization for spinal tumors.
Objective: To compare the difference of blood transfusion, perioperative blood transfusion and complications after preoperative embolization of spinal tumor, evaluate the clinical value of preoperative embolization. Materials and methods: 80 cases, 40 cases of preoperative embolization group from 07 months to 01 months of 2012 and 40 cases of preoperative embolization group, mean age 47 + 15.9 years old, Among them, there were 24 males, 16 females, 18 thoracic vertebrae, 9 cases of lumbar vertebrae, 13 cases of sacral lesions and 40 cases of the control group (not embolism), the average age was 46.1 + 17.9 years old, including 25 males, 15 cases, 17 cases of thoracic vertebrae, 13 cases of lumbar vertebrae and 9 cases of sacral lesions.
Results: 40 patients in the embolization group underwent a total of 188 blood supply vessels of the tumor, and 167 of them were embolized. The amount of bleeding in the embolization group was 1740 + 746ml, and the amount of bleeding in the control group was 2516 + 1374ml. There were significant differences between the two groups (P0.01). The blood transfusion volume in the perioperative period of the embolization group was 1425 + 1348ml, and the control group was 1845 + 134. 8ml, there was no significant difference between the two groups (P0.05). There was no embolism complication and operative complication in the embolization group, but 2 cases in the control group.
Conclusion: preoperative embolization for spinal tumors is a safe and effective measure, which can significantly reduce intraoperative blood loss and reduce intraoperative complications.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R738.1;R445.2

【相似文献】